The elastin content of the vagina is decreased in pathological processes such as pelvic organ prolapse, stress urinary incontinence and aging (atrophic) vaginitis. A significant risk factor for the development of these conditions, aside from aging, is trauma to the pelvic floor, most commonly due to a history of vaginal delivery. During labor and delivery the pelvic floor, including the vagina, undergoes significant changes secondary to the mechanical trauma that the tissue endures during delivery. In the post partum period many pelvic floor injuries resolve but frequently symptoms of prolapse and stress urinary incontinence are present in a mild form. As aging occurs the symptoms of prolapse, incontinence and vaginal atrophy become much more bothersome.
The vaginal wall is comprised of three tissue layers the epithelium, the lamina propria, and the muscularis. The vaginal wall contains a significant amount of smooth muscle providing support and structure for the vagina. In addition, these smooth muscle cells are capable of synthesizing components of the extracellular matrix; substances such as elastin through the precursor tropoeleastin and collagen which are responsible for the elasticity and strength of the vaginal wall.
Currently only estrogen is available for the treatment of atrophic vaginitis. However, estrogen has multiple side effects and may lead to the development of cancer or precancerous conditions and for this reason many women are afraid to take it or cannot take it because of a personal history of breast cancer or other estrogen sensitive cancers. No pharmaceutical treatment is currently available for the prevention of stress urinary incontinence or pelvic organ prolapse.